HSPH Professor Helps with Vermont Health Care Reform

William C. Hsiao is not an imposing man. He stands barely five feet eight inches tall and at age 75 affects an air of unpretentious expertise. He speaks slowly, in accented English—a remainder of his immigrant childhood—that expresses his ideas simply and logically, point by point.

Despite his approachability and clarity, the points that Hsiao, an economics professor at the Harvard School of Public Health, has chosen to study and argue are neither simple nor without controversy. Their ramifications stretch around the world, directly impacting millions of lives.

Hsiao is the world’s leading expert on single-payer health care systems. His economic expertise, accumulated through years of research and work in the private and public sectors, is much sought after by governments across the globe. To date, Hsiao has worked with nearly a dozen different countries, analyzing and implementing single-payer universal health care systems from places like Taiwan to South Africa.

“If I was a country or a state and I wanted to set up a public health care system, he’s the guy I would call,” said Robert J. Blendon, a professor of health policy and politics at the School of Public Health. “He’s just one of the best in the world.”

The current economic climate and demographic shifts around the globe have pushed Hsiao’s work to the forefront of international health policy. With governments around the world seeking to cut public expenditures and deal with growing and aging populations, the question of how to contain health care costs has become the topic of conversation in just about every capital. One way to approach that two-pronged crisis is to put in place a single-payer health care system, which provides health care to all citizens through a single, publicly-financed insurance fund with uniform coverage and rates.

Nearly two years after Congress passed the Patient Protection and Affordable Care Act, the prospect of putting in place a single-payer system in the United States is all but dead. Consequently, states have begun to take reform into their own hands.

In the spring of 2010, legislators in Vermont began laying the groundwork for a single-payer system and asked Hsiao to study possible health care reform options for the state. Hsiao’s analysis—part of the Program in Health Care Financing he directs at the School of Public Health—became the basis for House Bill 202, which made Vermont the first state to enact a single-payer health system when it was signed into law in the spring of 2011.

Hsiao’s work in Vermont is making some advocates of health care reform—and specifically of a single-payer model—hopeful that the reform effort in that state could serve as a model for other states, advancing an effort on the state level that faces little to no prospect of success on Capitol Hill.

THE TECHNOCRAT

Hsiao styles himself as a non-ideological technocrat. He isn’t out to prove the ideological superiority of a market-based model or a socialist system—he’s simply out to put in place the best, most efficient health care system possible. And that’s what makes his effort in Vermont so attractive for many health care reformers. While there is significant debate over exactly what such a system looks like, Hsiao’s research seeks to place itself above the ideological controversies of the health care reform debate.

Hsiao’s impact on the world of health care is unique. He is not a politician or a political advocate. Nor is his background primarily in health studies. Rather, Hsiao is trained as an actuary and political economist. Accordingly, his approach to health systems is economic—not moralistic—and largely apolitical.

As Hsiao explains it, his work is based on two fundamental economic dilemmas facing health systems: lack of universal coverage and the rapidly escalating cost of care. The first of these problems is easily fixed but only increases cost. The second is more systemic and can only be resolved with complete systemic reform, Hsiao says.

Single-payer health care, Hsiao’s area of expertise, is one such approach to systemic reform. Though Hsiao is a proponent of this method, he is careful not to label himself as an advocate. He does not lobby or even advise legislation without an invitation to do so, preferring to let his analysis speak for itself.

“I’m trying to do impartial study based on evidence. I will advocate the research results I have produced into policy, but I would not make it a human-rights issue,” said Hsiao. “I just argue it delivers better results.”

Hsiao’s mixed background in economics as well as politics has earned him an atypical footing in the world of health care. Unlike most health policy experts who focus on one aspect of reform, Hsiao considers the whole picture: not only the economics of a health system, but also a country’s politics, history, and culture.